| NPI | 1760475735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX 666326) |
| Additional Taxonomies | 171400000X Health & Wellness Coach (Licence: TX 666326) |
| 202D00000X Integrative Medicine (Licence: TX 666326) | |
| 207QA0000X Family Medicine, Adolescent Medicine (Licence: TX 666326) | |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: TX 666326) | |
| 2083B0002X Preventive Medicine, Obesity Medicine (Licence: TX 666326) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 666326) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 666326) | |
| 363L00000X Nurse Practitioner (Licence: TX 666326) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2024-09-19 |